-Strategies to Reduce &
Eliminate Horizontal &
Lateral Violence at the
Unit Level-
Presented by:
Lauren Tronsgard –Scott
BSRN
Linda Knight APRN
Elaine Koenig BSRN
-Catalysts• Speaking at charge nurse workshop on
situational leadership
• Reports of horizontal violence on our
units by new and ancillary staff
• Nurse’s Week Grand Rounds on Nurse
to Nurse hostility and health
relationships
• Personal experience
-Horizontal ViolenceA consistent (hidden) pattern of behavior
designed to control, diminish,
or devalue another peer (or group)
that creates a risk to health
and/or safety
(Quine 1999, Farrell 2005)
-Horizontal ViolenceOvert:
name-calling, sarcasm, bickering, fault-finding, backstabbing, criticism, intimidation, gossip, shouting,
blaming, put-downs, raising eyebrows, etc.
Covert:
unfair assignments, eye-rolling, ignoring, making faces
(behind someone’s back), refusal to help, sighing,
whining, sarcasm, refusal to work with someone,
sabotage, isolation, exclusion, fabrication, etc.
Horizontal Violence AKA:
•
•
•
•
•
Lateral Violence
Workplace Incivility
Bullying
Workplace Aggression
Nurses Eating Their Young
Why Should We Promote Civility,
Communication, Teamwork?
• It’s all about
the Patient
What we have done….
-“Poll the Audience”-
• Survey of multi-disciplinary staff
- Nursing 2011 horizontal violence survey. Dumont, Cheryl PHD, RN, CRNI;
Riggleman, Kammie MSN, RN, NEA-BC; Meisinger, Sandy BSN, RN;
Lein, Alicia BSN; RN, CCRN
-Survey of multidisciplinary
staff•
•
•
•
•
•
•
•
•
•
•
•
•
•
Within the last 12 months, how often have you personally experienced or
witnessed the following: Harshly criticizing someone without having heard
both sides of the story.
never
once
a few times
monthly
weekly
daily
Within the last 12 months How often have you personally experienced or
witnessed the following. Complaining about a co-worker to others instead of
attempting to resolve a conflict directly by discussing it with that person?
never
once
a few times
monthly
weekly
daily
-Presented plans to our psych
practice council-
Results of Survey….
Inpatient Psychiatry
Survey Responses
Answer these questions from the perspective of how you personally have
been affected within the last 12 mos; I’ve not spoken up about something
because of fear of retaliation.
Never
Once
A few times
Monthly
Weekly
Daily
54.9%
5.6%
25.4%
5.6%
8.5%
0%
39
4
18
4
6
0
Inpatient Psychiatry
Survey Responses
Answer these questions from the perspective of how you personally have
been affected within the last 12 mos; I have hesitated to ask a question for
fear I would be ridiculed.
Never
Once
A few times
Monthly
Weekly
Daily
66.2%
0%
23.9%
4.2%
5.6%
0%
47
0
17
3
4
0
Inpatient Psychiatry
Survey Responses
In general, horizontal or lateral violence occurs on psychiatry?
Never
33.8%
24
Once
2.8%
2
A few times
28.2%
20
Monthly
8.5%
6
Weekly
16.9%
12
Daily
9.9%
7
-Placed Commitment to my Co-worker
laminated poster in several locations on
units- (Creative Heath Care Management, Inc)
-Bought “Commitment to my Co-
worker” pins and cards-
• Encouraging staff to meet with each other and facilitating
conversations with staff to address communication
issues, summing up conversation by giving out pins and
cards to those in attendance.
-Popcorn and a Movie“Healing Nurse-to-Nurse Hostility and Creating
Healthy Relationships”
Presented by:
Kathleen Bartholomew, RN, MN
National Speaker and Author of “Speak Your Truth: Proven Strategies for Effective Nurse-Physician Communication;”
“Ending Nurse to Nurse Hostility,”
“Stressed Out About Communication,”
and “The Image of Nursing”
Kathleen’s thoughtful presentations inter-laced with research reawaken every nurse’s commitment and love of nursing.
Her most ardent desire is to empower nurses through knowledge and the power of story. Come and be inspired!
-We Shared the Results of the Survey
before showing the movie-
Commitment to My Coworkers Card
included with each bag of popcorn!
• Over 40 staff viewed the video during 3
presentations – Standing room only!
-Commitment to My CoWorkers Poster-
-”Feedback Board”-
Sample Comments:
• “ The silence is painful and not helpful
at all.”
• “This article illustrates how standing
up for yourself engenders respect and
can alter dynamics in the relationship.”
-Added annual evaluation goal: To
reduce and eliminate horizontal and
lateral violence on Inpatient Psychiatry
by using Caring and Collaborative
Communication-
-”Walking the Walk”• Talking about how I (Lauren) plan to improve my
own communication style and holding myself
accountable in front of other staff members.
Apologizing publicly if needed. Making a
commitment as a manager to make this a priority
and project in the next year 2012.
“Managers are the culture carriers of the
organization.”
- Farrell (2005)
-Commitment to CoworkersLinda and Elaine emphasize our
commitment to no horizontal
violence when orienting new staff
to our units
FAHC Standards of Excellence
-Purchased books for units by
Kathleen Bartholomew-
-Addressing and meeting with identified staff
on our units to assist them in getting greater
awareness about their communication style
and offer assistance for improvement. (Gave
out crucial conversation book)-
FAHC offers Crucial Conversation Program
which Linda (Clinical Nurse Specialist) and
Elaine (Nurse Educator) have attended
-Sharepoint Blog – Lauren’s
DeskWhy should we spend time on relationships?
How we treat each other has a direct impact on our ability
to produce quality work. When we are ineffective communicators
or don't trust and respect one another, delays in accomplishing
our work occur. We can create safety issues by not speaking up
or to another employee. Patients are impacted by our ability to
communicate as a team.
HIT BY IRENE!
-Anecdotal Evidence-
-Future Plans• Resurvey our staff
• Continue to post information on
horizontal violence
• Encourage staff to communicate
openly about lateral violence when it
occurs
• Support staff in attending Crucial
Conversations classes and
conferences dealing with related topics
-Finding Our Voice• “The truth is that neither checklists, nor
procedures, or process improvement will work in
the absence of meaningful, collegial
relationships in which every member of the team
feels comfortable communicating what they see,
feel and know at all times. Silent cultures never
change. Find the courage. Find your voice.”
•
- Kathleen Bartholomew RN,RC,MN (2009)